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We are failing to improve the evidence base for ‘exercise referral’: how a physical activity referral scheme taxonomy can help
  1. Coral L Hanson1,
  2. Emily J Oliver2,
  3. Caroline J Dodd-Reynolds2,
  4. Paul Kelly3
  1. 1 School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
  2. 2 Department of Sport and Exercise Sciences, Durham University, Durham, UK
  3. 3 Physical Activity for Health Research Centre, Institute of Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Coral L Hanson, Edinburgh Napier University, Edinburgh EH11 4DN, UK; c.hanson{at}

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Increasing physical activity (PA) is a global public health priority.1 For decades, exercise referral schemes (ERS) have been a popular way for healthcare professionals in primary and secondary care to help patients increase their PA.

Delivery of ERS varies widely, with the construction of an evidence base informing ‘what works best’ limited by a lack of understanding about what individual schemes deliver and how.2 Between-scheme analyses are extremely challenging due to varying quality of reporting (eg, of scheme delivery components and processes) and evaluations.3 4 As a consequence, overviews of ERS evidence5 6 are flawed by combining heterogeneous interventions (eg, falls prevention via physiotherapist referral and hypertension management via general practitioner (GP) referral) and datasets.

Collectively, the underwhelming findings of such overviews lead to concerns over commissioning ERS, and the inability of national policy and best practice guidelines to recommend a ‘gold standard’ structure, or even comment on ‘what good looks like’.5 We do not know whether local tailoring of ERS is more effective and efficient than a standardised approach.

To advance knowledge …

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  • Twitter @HansonCoral, @narrowboat_paul

  • Contributors CLH and PK: developed the initial concept of a physical activity referral taxonomy and drafted initial ideas. EJO and CJD-R: contributed to the refinement of the initial concept. All authors were involved in the preparation of the final document; contributed to this editorial and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.